Sunday, September 24, 2017

The Politicizing of Zika



By on August 11, 2016

The Politics of Health or How a Mosquito Comes Between an Elephant and a Donkey

After more than 7,200 confirmed cases of the zika virus in Puerto Rico since November 2015, and 16 confirmed cases in Florida this month, the spread of the mosquito-borne virus seems to continue unchecked by political authorities in the U.S., who have been mired in a debate over secondary elements included in the proposed legislation to provide funding against the disease rather than dealing with the health emergency itself.

In June, Democrats in the U.S. Senate blocked the federal spending bill that would have allotted more than $1.9 billion to fight the zika virus.

“I don’t know why anyone would vote for it… Look at what they gave us. How about the Confederate flag thing? Is that about the clincher?” asked Sen. Jon Tester (D-Mont.) at the time, suggesting Republicans were playing politics with the issue.

The Democratic Party delegation in the Senate argued that Republicans included politically charged elements in the bill that made it impossible for them to pass it. According to Democrats, some of those elements would have specifically limited the federal government’s ability to attend to significant public health emergencies other than zika and open the door to more lenient environmental regulations for the use of insecticides.

Two of those elements are the provision allowing the Confederate flag to fly at U.S. veterans’ cemeteries and the cutting of funds to the Affordable Care Act, or Obamacare, and to programs providing access to contraceptive alternatives to women.

The blocking of the bill anticipated the possibility of no additional funding to battle zika, particularly now that the virus just reached the Sunshine State of Florida and is allegedly in the process of becoming a full-blown outbreak.

Back then, Republicans accused Democrats of justifying their lack of commitment with mere excuses for not passing the bill. Nevertheless, Republicans, for their part, did not respond to the allegations denouncing that some of the bill’s contents had been designed to promote some party policies.

Truth be told, Democrats and the Obama administration had been pushing since early 2016 for the approval of $1.9 billion in emergency financing to fight zika. Now, perhaps because the virus has reached stateside, there is some discussion on the need to revisit the subject even on the Democratic side.

Puerto Rico and mosquitoes

Amid this political power-play comes Puerto Rico with what has been described by federal and local authorities, and the media, as a widespread epidemic of zika.

Earlier this year, Gov. Alejandro García Padilla characterized the economic and fiscal crisis on the island—including the spread of zika—as a “humanitarian crisis” in what many criticized as an effort to get the Puerto Rico Oversight, Management & Economic Stability Act (Promesa) to pass in Congress. According to critics, the García Padilla administration went even further and presented an “overblown” version of the crisis, apparently hoping to get some sort relief package / fund that would serve to mitigate not only the effects of the zika virus crisis, but also those of the economic and fiscal crisis.

Later in the year, the García Padilla administration would have a change of heart after realizing neither President Obama nor Congress were considering the possibility of a bailout for Puerto Rico through a relief package within Promesa. But it was too late for that. García Padilla’s pitch of the humanitarian crisis was so good that Obama devoted his July 1 weekly address to zika and Puerto Rico as a focus of the virus.

President-Obama-Weekly-Address

President Obama devoted his July 1 weekly address to zika and Puerto Rico as a focus of the virus.

“We have a crisis right now in Puerto Rico surrounding zika and we have to obtain the resources to make sure that we are engaging in mosquito abatement and providing the kind of basic health services to reduce the effects of zika in Puerto Rico. And at a time when Puerto Rico is already going through a tough time and its public health infrastructure is being strained because of budget constraints and debt problems, it’s especially important that we’re responsive to the millions of [U.S.] American citizens who live there,” Obama said in his message.

For many, particularly in Puerto Rico, it seemed the president was paying special attention to the situation on the island after submitting the budget request to fight zika.

But to some observers, that was not necessarily the case. In his remarks Obama had explicitly said that, while the request was directed at obtaining the resources “to make sure that we are engaging in mosquito abatement and providing the kind of basic health services to reduce the effects of zika in Puerto Rico,” the goal was to “to get those tests done so that in fairly short order we might have a vaccine available and people wouldn’t have to worry about this.”

The $1.9 billion slated for the battle against zika is still stuck in Congress, with the president blaming the Republicans in both the House and Senate for not having “come together in a sensible way to put forward the dollars that we have requested that have been budgeted to get the job done.” Nevertheless, it was Democrats in the Senate who blocked the bill, thus giving way to the blame game.

“So what I want the [U.S.] American people to understand is that I expect Congress to get this funding done before they leave for vacation, before they adjourn. That’s part of their basic responsibility. We put forward a budget request of $1.9 billion,” Obama said. “We didn’t draw that figure from the clouds—it was based on the assessment of our scientists and our experts in terms of what was going to be needed for basic mosquito abatement and vaccine development, and making sure that we’ve got the proper diagnostic tools so that we can respond effectively to protect the health and safety of the American people.”

Conflicting reports

According to the Puerto Rico Health Department, there were 3,374 cases of zika virus infections reported from July 8-14. Health Department statistics show a sharp increase in the number of confirmed cases this summer that is almost three times the number of cases reported for the first week of May.

For those same periods, the number of reported cases of pregnant women infected with zika increased more than five times when compared to the early May statistics: 788 versus 139. It should be noted that since November 2015, the statistics for pregnant women are reported weekly on a cumulative basis, unlike the statistics for the general zika infection, which is reported on a cumulative weekly basis only for 2016.

However, statistics reported by the U.S. media seem to come from different sources. For instance, on July 30, the New York Times (NYT) reported there are “about 5,500 confirmed infections on the island, including of 672 pregnant women. But experts at the Centers for Disease Control & Prevention (CDC) said they believe that is a “radical undercount.”

The fact is the “5,500 confirmed infections” statistic cited by the NYT is not the correct statistic. For the period of July 8-14, the number of confirmed cases, as reported by the Health Department, was 3,374.

The 5,500 cases figure is closer to the 5,203 suspected cases reported for the same period by the government agency.

On the other hand, an Aug. 1 article published by Time magazine reported that “5,582 people in Puerto Rico have tested positive for zika, which is thought to be a gross underestimate since most people who get the virus don’t show symptoms.” Again, the error in the statistic reported by the magazine is similar to the one made by the NYT, as they both incorrectly referred to the number of confirmed cases when they should have referred to the number of suspected cases.

The fact that two respected publications in the U.S. have reported incorrect data regarding the zika virus could be due to any number of reasons, including the possibility that their sources, mainly the CDC is not necessarily providing the correct data, which in turn could be due to any number of reasons.

Zombies and the land of the living dead

Dr. Anne Schuchat; President of Center of Disease Control; public speech

Dr. Anne Schuchat, principal deputy director at the Centers for Disease Control and Prevention

As a matter of fact, on April 11, Dr. Anne Schuchat, the principal deputy director at the CDC, said during a White House press briefing that the spread of the virus in Puerto Rico was practically out of control.

“We are quite concerned about Puerto Rico, where the virus is spreading throughout the island. We think there could be hundreds of thousands of cases of zika virus in Puerto Rico and perhaps hundreds of affected babies,” said Schuchat then, without presenting any evidence to support her claims.

For many critics, Puerto Rico has become, from a medical standpoint, “the land of the living dead.”

For example, the NYT’s July 30 article reported that “tests on donated blood, the most reliable barometer of the epidemic’s spread, show that almost 2% of the donors were infected in the past 10 days.”

But according to an article published in June by the Medscape Medical News website, 68 out of 12,777 (0.5%) blood donations in Puerto Rico have tested positive for the virus. The report does not specify when the blood was collected, but mentions that “since April 3, blood centers in Puerto Rico have screened locally donated blood for the zika virus, using a highly sensitive, highly specific, nucleic acid amplification test (Roche) that measures the zika virus in the blood as part of a blood safety program that is keeping the virus out of the blood supply.” So, presumably, the blood had to be collected between April and June 2016.

Contrary to the NYT’s assertion identifying the analysis of blood donations as the only “reliable barometer,” the truth is that there are other mechanisms to gauge the spread of zika. The P.R. Health Department now requires every Ob-Gyn seeing a pregnant patient to order a lab test to determine whether she has been infected with the virus and if the fetus could be at risk of the birth defect microcephaly, or an abnormally small head.

Tahiti before Puerto Rico

In an island of roughly 3.5 million inhabitants, an estimation of hundreds of thousands of zika cases could move many people to believe they face a catastrophe of pandemic proportions.

As serious as the situation in Puerto Rico could be, it is still far from the largest zika outbreak ever recorded, according to a March 2016 article in the Lancet medical journal. Between 2013 and early 2014, before the zika virus found its way to the Caribbean and Puerto Rico, it is estimated that almost 20,000 people in French Polynesia (Tahiti) were infected with the zika virus, out of a total population of some 277,000 people. That represents an infection rate of 7.2%.

In Puerto Rico, after nine months of zika’s presence, only 7,286 confirmed cases have been reported since November 2015.

Before 2013, there had been no reports of zika affecting Tahiti, so when the first symptoms started to appear among its population, medical authorities thought it was a new outbreak of dengue fever, which is common in that region and is also spread by mosquitoes. Nevertheless, once a person has been infected with dengue several times, it is unlikely that he or she could be affected by a mild form of the virus again.

“We were suspicious of this being dengue because all these people already had dengue,” said Dr. Van-Mai Cao-Lormeau of the Institut Louis Malarde in Tahiti, to the National Public Radio (NPR).

The outbreak in Tahiti began in October 2013 and ended in April 2014—after six months—and peaked in December 2013. During that period, not a single case of microcephaly was reported, despite the fact that zika is currently associated with the development of neurological malformations in fetuses from mothers who had been infected with the virus.

The link between zika and microcephaly, and other neurological congenital conditions, emerged when reports from Brazil pointed to several cases of microcephaly after a mother had been infected with zika.

Nevertheless, after the data from Brazil reached Van-Mai in Tahiti, she did a retrospective investigation to identify congenital conditions in children born during the October 2013 and April 2014 period that could be attributed to zika.

“We had 17 cases of central nervous system malformations in either fetuses or babies from mothers who had been exposed to zika during the outbreak,” said Van-Mai to NPR, referring to conditions ranging from deafness, blindness and limited fetal growth, among others.

In Puerto Rico, positive tests of the virus have jumped from 14% in February to 64% in June, and 2% of the territory’s blood supply has tested positive for zika.

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